How Psychological Safety Affects Team Performance: Mediating Role of Efficacy and Learning Behavior

Patient engagement with psychological safety

Psychological safety is a multidimensional, dynamic phenomenon that concerns team members' perception of whether it is safe to take interpersonal risks at work. It is particularly important within health care teams who need to work interdependently to coordinate safe patient care within a highly complex, variable and high-stakes work environment. High levels of psychological safety have clear benefits for patient safety by improving the delivery of clinical care and promoting health care providers' job satisfaction and well-being. Feeling psychologically safe can enable team members to engage in speaking up behavior, such as asking questions, pointing out mistakes, or reporting errors. Several studies have explored psychological safety in health care teams and its impact on patient safety. These studies have highlighted the importance of psychological safety in health care organizations and provided strategies for promoting psychological safety. Psychological safety in health care involvement with patients can improve patient engagement.

Psychological safety in medical education: A scoping review and synthesis of the literature

PURPOSE

Psychological safety (PS) is the belief that the environment is safe for risk taking. Available data point to a lack of PS in medical education. Based on literature in other fields, PS in clinical learning environments (CLEs) could support trainee well-being, belonging, and learning. However, the literature on PS in medical education has not been broadly assessed.

MATERIALS AND METHODS

In 2020, authors searched PubMed, Web of Science, CINAHL, Scopus, ERIC, PsycInfo, and JSTOR for articles published prior to January 2020. Authors screened all search results for eligibility using specific criteria. Data were extracted and thematic analysis performed.

RESULTS

Fifty-two articles met criteria. The majority focused on graduate medical education (45%), and 42% of studies took place within a CLE. Articles addressed organizational and team level constructs (58%), with fewer descriptions of specific behaviors of team members that promote or hinder safety. The impacts of safe environments for trainees and patients are areas in need of more exploration.

DISCUSSION

Future research should focus on defining specific organizational and interpersonal leader behaviors that promote PS, seek to understand how PS is determined by individual trainees, and measure the impact of PS on learners, learning, and patient care outcomes.

Knowledge mobilization in critical care and the evolving communication role of nurses

BACKGROUND

The importance of appropriate communication skills within a health care setting rests upon the need for effective information sharing. When successful, this provides a supportive working environment for staff and has a positive impact on patient care and outcomes.

AIMS

The purpose of this study was to explore how knowledge/evidence is acquired, shared, and applied in the Critical Care (CC) environment for staff and patients/family members.

STUDY DESIGN

A qualitative approach was used, consisting of semi-structured interviews and focus groups. Data analysis was conducted using an iterative thematic approach.

RESULTS

Data collected prior to the COVID-19 pandemic from United Kingdom (UK) critical care workers (N = 46), patients, and family members (N = 21) identified four communication roles performed by the nursing staff: team member; diplomat; translator and friend.

CONCLUSIONS

It was evident that without suitable training and support, the stresses and demands placed upon the nurses could lead to disenfranchisement and burnout.

RELEVANCE TO CLINICAL PRACTICE

These findings are relevant and timely given the impact of the pandemic, highlighting the need for accessible and alternate communication strategies to support nurses by reducing stress, moral distress and increasing psychological safety. Improved communication can provide tailored information for staff and patients/family improving the CC experience for all.

(Almost) 50 shades of an ethical situation - international physiotherapists' experiences of everyday ethics: a qualitative analysis

INTRODUCTION

Different cultures and societal structures influence the ethical experiences of physiotherapists.

OBJECTIVE

The study aimed to discover and describe contextual shades of ethical situations experienced by physiotherapists in their global practice.

METHODS

This paper reports the qualitative analysis of responses to an optional open question in an internationally distributed online survey (ESPI study) with 1,212 participants from 94 countries. All responses were coded to five categories describing the data's relationship to the survey list of ethical situations. Data that described new ethical situations were analyzed thematically.

RESULTS

Three hundred and fifty four individual responses to the optional survey question reported 400 ethical issues. Three hundred and seventy-eight of these issues were associated with the original survey questions. Twenty-two responses raised four new themes of ethical issues: lack of regulatory and/or accreditation policy and infrastructure, lack of recognition of the role and position of physiotherapists in healthcare, economic factors driving the conduct of practice, and political threats.

DISCUSSION

Local contexts and pressures of workplaces and societies in which physiotherapists practice make it almost impossible for some practitioners to comply with codes of ethics. Physiotherapists need support and preparation to respond to local affordances and the complexity, ambiguity, and sometimes messiness of ethical situations encountered in their practice.

CONCLUSION

The findings highlight the relevance of cross-cultural research in the field of physiotherapy, and the necessity of investigating and bridging the gap between professional ethics theory and practice in diverse settings.

The influence of authentic leadership on nurses' turnover intentions and satisfaction with quality of care in Saudi Arabia: A structural equation modelling study

AIM(S)

The study aimed to test a model that examined the relationships between authentic leadership, psychological safety, work engagement and team effectiveness and subsequent effects of team effectiveness on job turnover intentions and nurse satisfaction with quality of care.

BACKGROUND

Nurse leaders who exhibit authentic leadership have been shown to contribute to the development of healthy work environments. In workplaces with demonstrated authentic leadership, nurses are more engaged and have lower job turnover intentions.

METHOD(S)

A non-experimental, cross-sectional design was used to test the hypothesized model via structural equation modelling. A total of 456 nurses were included.

RESULTS

Structural equation modelling analysis indicated a good fit for the hypothesized model. Authentic leadership had a positive, significant and direct relationship with team effectiveness, nurses' work engagement and psychological safety. Team effectiveness was found to be negatively related to job turnover intentions but positively related to nurse satisfaction with quality of care.

CONCLUSION(S)

Results of this study may help nursing leaders have a better understanding of the essential role of leadership style in increasing healthy work environments.

IMPLICATIONS FOR NURSING MANAGEMENT

Applying authentic leadership style in nursing practice could help to reduce the shortage of nurses stemming from the high turnover intentions of nurses.

Clinician Teacher as Leader: Creating Psychological Safety in the Clinical Learning Environment for Medical Students

PURPOSE

Psychological safety is the perception that a group environment is safe for interpersonal risk taking, exposing vulnerability, and contributing perspectives without fear of negative consequences. The presence of psychological safety has been tied to wellness, retention, and inclusiveness. National data demonstrate that many of the fundamental components of psychological safety are lacking in clinical learning environments. There is evidence that leadership behaviors can create psychological safety in traditional work environments. The authors sought to understand how clinical teachers' leadership behaviors can create, destroy, and rescue psychological safety in the clinical learning environment.

METHOD

This was a multicenter, cross-sectional, qualitative study of fourth-year medical students from 2 institutions using semistructured interviews. Verbatim transcripts underwent constant comparison and iterative data reduction and analysis, continuing beyond thematic sufficiency.

RESULTS

Eighteen students participated in interviews. Participants described key themes of relationships, an emphasis on learning, clear expectations, autonomy, and frequent feedback as promoting psychological safety. Safe environments lead to a sense of belonging and agency. They reported educator disinterest in students, dismissal of questions, lack of autonomy, and unclear expectations as destructive of psychological safety. Unsafe environments lead to withdrawal and a high extraneous cognitive load. Most students were unable to describe a time psychological safety was restored if lost.

CONCLUSIONS

Clinical teachers' leadership behaviors can directly impact students' perception of psychological safety in the clinical learning environment. Psychological safety increases students' sense of belonging, self-efficacy, and engagement. The findings demonstrate that while it is difficult to repair an atmosphere that is psychologically unsafe, there are several actions that can be put into motion early on to ensure the learning environment is safe and remains so. Future research should investigate whether psychologically safe environments lead to meaningful differences in assessments of student learning and effective cultural change.

Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care

OBJECTIVE

To identify strategies and interventions used to improve interprofessional collaboration and integration (IPCI) in primary care.

DESIGN

Scoping review DATA SOURCES: Specific Medical Subject Headings terms were used, and a search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science.

STUDY SELECTION

In the first stage of the selection, two researchers screened the article abstracts to select eligible papers. When decisions conflicted, three other researchers joined the decision-making process. The same strategy was used with full-text screening. Articles were included if they: (1) were in English, (2) described an intervention to improve IPCI in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country, (4) were peer-reviewed and (5) were published between 2001 and 2020.

DATA EXTRACTION AND SYNTHESIS

From each paper, eligible data were extracted, and the selected papers were analysed inductively. Studying the main focus of the papers, researchers searched for common patterns in answering the research question and exposing research gaps. The identified themes were discussed and adjusted until a consensus was reached among all authors.

RESULTS

The literature search yielded a total of 1816 papers. After removing duplicates, screening titles and abstracts, and performing full-text readings, 34 papers were incorporated in this scoping review. The identified strategies and interventions were inductively categorised under five main themes: (1) Acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual; (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences.

CONCLUSIONS

We identified a mix of strategies and interventions that can function as 'building blocks', for the development of a generic intervention to improve collaboration in different types of primary care settings and organisations.

Effectiveness of the use of concept maps and simulated cases as a teaching-learning strategy in enhancing the learning confidence of baccalaureate nursing students: A qualitative approach

BACKGROUND

Didactic lectures and exam-oriented learning can lead to students becoming passive learners who rely on rote memory. This learning style negatively impacts their ability to cultivate the core nursing values and critical thinking.

OBJECTIVES

This study aimed to investigate the impact of a concept mapping teaching-learning strategy on undergraduate nursing students' ability to integrate theoretical biosciences knowledge into care practice and on their skills in critical thinking and teamwork.

METHODS

A qualitative research design was adopted. A course entitled Evaluation and Analysis of Adult Nursing Cases was developed based on a concept mapping strategy involving 24 simulated cases relevant to medical and surgical nursing. The participants were students from the two-year undergraduate nursing programme at a university in Taiwan. Data were collected from September 2020 to February 2021. Qualitative data were collected from semi-structured face-to-face interviews with 20 students and from 100 reflective reports on students' learning journeys. The data were analysed using qualitative content analysis.

RESULTS

Two major themes were identified: (1) changes in learning style and thinking and (2) rewards from learning. The participants reported that their learning style had changed from reliance on rote learning to image memory, and their thinking process from linear (cause-effect) to multifaceted thinking at different levels. The teaching and learning strategies contributed to feelings of ability advancement and psychological safety, which led to learning achievement and confidence.

CONCLUSION

The use of a concept mapping strategy and simulated cases enhanced students' learning by enabling them to integrate theoretical knowledge and improve their thinking abilities. The teaching and learning strategies helped participants in learning about psychological safety and increased their learning confidence.

Enhancing Toxicology Achievement by the VARK and the GRSLSS-mixed Models in Team-Based Learning

Toxicology is needed to implement in the occupational health and safety (OHS) curriculum. Teaching toxicology is very challenging as its multidisciplinary science. Keeping students engaged in learning is a difficult issue when introducing solely theoretical framework. To enhance student performance, educators need to be aware of different learning styles and teach students accordingly. This study aimed to examine preferred learning styles and to further investigate the impact of learning style on team allocation and the effectiveness of team-based learning (TBL) in toxicology. A cross-sectional study of OHS students was performed. The visual, aural, reading/writing, and kinesthetic (VARK) learning style questionnaire and the Grasha–Reichmann Student Learning Styles Scale (GRSLSS), which identifies independent, dependent, collaborative, participant, competitive, and avoidant learning styles, were used with 101 study participants. After classification, participants studied three aspects of toxicology in three respective situations: (i) individual learning, (ii) TBL with students of the same VARK learning style, and (iii) TBL with students of varying VARK learning styles. Afterward, participants wrote a test on each of the aspects. The dominant VARK and GRSLSS learning styles were reading/writing (33.33%) and collaborative (50.00%), respectively. The participants achieved the highest test scores (88.31%) when they studied in a team with the various VARK styles, followed by studying in a team with the same VARK style (83.43%). Individual learning produced the lowest average score (69.79%). The results of this study suggest that creating a successful heterogeneity team based on the preferred learning styles is an effective teaching method in toxicology. It might be useful to toxicology educators and research studies from a wide range of disciplines to enhance student performance.

How to Solve the Time Dilemma? The Influence of Team Temporal Leadership on Team Innovation Performance

Time pressure (TP) is the most common kind of pressure faced by R&D teams. How to improve team innovation performance (TIP) when time resources are insufficient has been a concern of practitioners and scholars. The purpose of this paper is to put forward some suggestions to solve that time dilemma. We conducted a survey based on a sample of 163 teams. In the first-stage survey (time 1), we measured the team temporal leadership (TTL) and TP. In the second-stage survey (time 2), we measured team learning behavior (TLB). TIP was measured in the third-wave survey (time 3). The results are as follows: (i) TTL has a significant positive impact on the TLB and TIP; (ii) TLB plays a mediating role in the relationship between TTL and TIP; and (iii) TP can positively moderate the relationship between TTL and TLB, that is, the promoting effect of TTL on TLB is more pronounced under the higher level of TP. These findings reveal the influence mechanism of TTL on TIP from the perspective of TLB and TP.

Multiple Team Membership, Performance, and Confidence in Estimation Tasks

Multiple team membership (MTM) is a form of work organization extensively used nowadays to flexibly deploy human resources across multiple simultaneous projects. Individual members bring in their cognitive resources in these multiple teams and at the same time use the resources and competencies developed while working together. We test in an experimental study whether working in MTM as compared to a single team yields more individual performance benefits in estimation tasks. Our results fully support the group-to-individual (G-I) transfer of learning, yet the hypothesized benefits of knowledge variety and broader access to meta-knowledge relevant to the task in MTM as compared to single teams were not supported. In addition, we show that individual estimates improve only when members are part of groups with low or average collective estimation errors, while confidence in individual estimates significantly increases only when the collective confidence in the group estimates is average or high. The study opens valuable venues for using the dynamic model of G-I transfer of learning to explore individual learning in MTM.